周凯华　陈铭吉　陈农　庄健　潘福根

(复旦大学附属中山医院青浦分院骨科, 上海　201700)



·论著·

创伤骨科患者术后发热的发生率及病因诊断

周凯华陈铭吉陈农庄健潘福根

(复旦大学附属中山医院青浦分院骨科, 上海201700)

摘要目的：研究创伤骨科患者术后发热的现况并探讨病因相关诊断性检查方法的意义。方法： 2011年1月—2013年12月收治的1396例创伤骨科患者中286例患者出现了术后发热(体温高于38.5℃)，对这些患者进行尿常规、尿培养、血培养或伤口渗出液培养等检查并摄X线胸片，以明确发热原因，记录相应结果。结果： 365例次检查中38例(10.4%)为阳性结果，分别为尿常规检查19/92(20.6%)、尿培养11/103(10.7%)、X线胸片5/62(8.1%)、血培养3/103(2.9%)、伤口渗出液培养0/5(0%)。3例血培养阳性者均为术后1周仍有发热的患者。术后6 d后出现发热的患者诊断性检查的阳性率(40%)高于术后5 d内出现发热的患者(8.7%)，差异有统计学意义(P<0.01)。结论： 创伤骨科患者术后发热较常见，术后早期发热可能由炎性反应或早期贫血所致，感染相关诊断性检查阳性率较低；手术6 d以后出现发热，应警惕术后感染。

关键词术后；发热；流行病学;病因

Incidence and Diagnosis of Postoperative Fever in an Orthopedic Trauma Population

ZHOUKaihuaCHENMingjiCHENNongZHUANGJianPANFugen

DepartmentofOrthopedicSurgery,QingpuBranchofZhongshanHospital,FudanUniversity,Shanghai201700,China

AbstractObjective： To investigate the epidemiological status of postoperative fever in an orthopedic trauma population and explore the significance of related diagnostic evaluations.Methods： Among the 1396 orthopedic trauma patients,who were admitted during January 2011 and December 2013,there were 286 patients developing postoperative fever (oral temperature ≥38.5℃). In order to confirm the fever origin, urinalysis, urine cultures, blood cultures, wound cultures, and chest radiographs were performed and subsequent results were recorded. Results： Three hundred and sixty five diagnostic tests were ordered with 38 being positive(10.4%). Yields per individual test were as follows: urinalysis, 19/92 (20.6%); urine cultures, 11/103 (10.7%); chest radiograph, 5/62 (8.1%); blood cultures, 3/103 (2.9%); wound cultures, 0/5 (0%). Three patients with positive blood cultures had fever one week after operation. The positive rate of diagnostic evaluations in patients developing fever 6 d after operation (40%) was significantly higher than that in patients developing fever within 5 d (8.7%), the difference was significant (P<0.01). Conclusion： Postoperative fever is common among orthopedic trauma patients. Fever developed in the early postoperative period may be caused by inflammatory reaction or early anemia, and the related diagnostic evaluations have a low-positive yield. If a fever was found 6 d after operation, then physicians should be vigilant against postoperative infection.

Key WordsPostoperative;Fever;Epidemiology;Etiology

外科患者术后发热比较常见[1-2]。炎性介质和术后早期贫血是发热的常见因素[2-5]。此外，感染也是引起术后发热的原因之一。为了明确术后发热的原因，通常进行血常规、血培养、尿常规、尿培养以及X线胸片等检查，但很多情况下这些检查结果并不能明确发热原因[1，4，6-9]。

目前，关于术后发热的文献较多，骨科专业中的相关研究主要集中于关节置换患者，相对而言，有关创伤骨科患者术后发热的研究则较少。本研究旨在探讨创伤骨科患者术后发热的现况及相关诊断性检查的意义。

1资料与方法

1.1一般资料2011年1月—2013年12月，我院共收治创伤骨科患者1621例，将术后发热患者纳入本研究。……